Basic Information
| Provider Information | |||||||||
| NPI: | 1295824209 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | MARGARET | ||||||||
| MiddleName: | HUMPHREY | ||||||||
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| Credential: | R.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3471 STUART ST | ||||||||
| Address2: | |||||||||
| City: | WINNEMUCCA | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894454155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7756234014 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 118 E HASKELL ST | ||||||||
| Address2: | |||||||||
| City: | WINNEMUCCA | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894453247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7756235222 | ||||||||
| FaxNumber: | 7756235904 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.